Dr. Casey Means is an award-winning biomedical researcher who’s worked at the NIH, Stanford School of Medicine and NYU. She’s spent much of her career studying the impact of daily choices and habits on people’s health. She’s now the Chief Medical Officer for Levels Health, a tech startup that uses continuous glucose monitoring to provide users with instant biofeedback data and suggestions on how to improve their overall health. On this episode of Salad with a Side of Fries, Jenn Trepeck talks to Dr. Means about all the ways metabolic dysfunction presents itself, the four pillars of metabolic health, and the future of tech and wellness.
10:59 – What is metabolic health?
Metabolism is how our cells make energy from our food and environment. Metabolic health is that system performing at its best.
“How I would define metabolic health is a very, very smooth process of metabolism. You’re generating inner energy efficiently. You’re utilizing your substrates effectively. You’re able to flip-flop between using glucose or using fat based on what energy is available and you’re not generating undue byproducts in that whole pathway. So, what I mean by that is that throughout that process, you’re not doing in a way that’s generating excess inflammation or things like free radicals or that you’re overloading the system with too much of those building blocks and then having an excess, which can cause problems in the body. Having those metabolic processes running smoothly is metabolic health. And then the question is sort of like, what does that look like? That looks like a body running smoothly. It looks like our organ systems running properly, minimization of symptoms, having really good energy, good mood, good overall health, and kind of just feeling really smooth and stable and at peace in life.”
14:11 – What is metabolic syndrome?
Since metabolism is a function of our cells, dysfunction can show up anywhere in our bodies.
“So really metabolic dysfunction can show up in almost any organ system, and we’re learning more and more that so many common diseases and symptoms that we deal with in the United States are fundamentally actually rooted in metabolic problems. For instance, we know that polycystic ovarian syndrome, it’s the leading cause of infertility in the United States, and this is very tied in with metabolism. Some people call it insulin resistance of the ovaries. So when the ovaries aren’t doing the proper job at responding to the hormonal cues of metabolism like insulin, you can essentially get problems with fertility and the balance of hormones between male and female hormones. If this is happening in the liver, it might look like fatty liver disease. If this is happening in the cardiovascular system, it could look like high blood pressure or heart disease. If it’s happening in the brain, it could look like fatigue, chronic pain, brain fog, or even in a later stage, Alzheimer’s dementia.”
17:04 – It all comes back to blood sugar
In the past 50 years, we’ve begun eating more processed sugars and refined carbohydrates and that has led to insulin resistance in our bodies.
“When you trigger that release of insulin over and over and over again, what happens is the cells are sort of getting numb to it. They’re like there’s so much of this insulin around. We’re going to kind of get numb to it. And the body then has to actually produce more insulin to drive the same amount of glucose into the cells. So now you’ve got a situation where you’re having to overcompensate with insulin because your cells are a little resistant to it, and this is called insulin resistance. What happens in this process is that your insulin levels rise and that insulin has a secondary effect, which is that it actually tells the body, okay, we’ve got tons of glucose around, we don’t need to burn any fat. And so it basically is a blocker on fat burning. This is a problem with our high refined sugar, high refined carbohydrate lifestyles is that we become, we get our insulin levels elevated. It tells us to stop burning fat. And then what can happen is fat is getting deposited all over the body. It’s getting deposited in the blood vessels. It’s getting deposited in the liver. It’s getting deposited in muscle cells, obviously in our fat cells. And you also are getting this insulin resistance showing up all over the body. What happens over time is your cells can become so insulin resistant that they actually have trouble getting the glucose into cells at all and then you’ve really got a problem, because you’re not able to get enough glucose into the cells for energy. You’re not able to burn fat for energy and then you start seeing cells struggling. And this is where all these different symptoms arise.”
21:43 – Food isn’t the only thing that affects glucose levels
It’s easy to see where food and sugar intake can affect blood glucose levels, but exercise and sleep are also major players in metabolism.
“Sleep has a huge impact on our glucose levels and our baseline metabolic health. Sleep impacts insulin levels directly. It impacts cortisol, growth hormone, and our hunger and satiety hormones, ghrelin and leptin. So from many different angles, it can have an impact on glucose. Exercise is a huge one as well. Not using our major muscle groups throughout the day can really set us back in terms of our glucose control. Even if you just get up and walk around for two minutes, every half hour. When you think about it, these huge muscle groups like the quads and the hamstrings and the calves just by walking around and by doing that, all those cells in those muscles need glucose, so it’s serving as a glucose sink, even just walking around. The more that you can activate those pathways throughout the day, even just for two minutes every half hour, that can really improve outcomes. And then of course exercising, whether it’s resistance training, high intensity interval training, even yoga – all these things can help with insulin sensitivity and glucose control.”
23:01 – Don’t forget about stress management
Stress causes our body to release cortisol and that raises our blood glucose levels, which used to be beneficial to our survival, but that isn’t true in our modern lives.
“Stress has a very profound impact on our metabolic health. When we’re stressed, our body releases cortisol and other catecholamine hormones that tell our body that there’s some sort of threat that we need to respond to. And historically that threat typically would have been physical, like way back in the day. You know, they always use the example of being chased by a lion. Feeling stressed would have been because you probably have to activate and do something physically. So it actually made a lot of sense for cortisol, which is the stress hormone, to raise our blood sugar levels because we needed sugar for the muscles. Basically what happens is you feel stressed, whether it’s a physical or psychological stress, and your liver dumps out its stored glucose into the bloodstream. You’ll see your blood sugar rise and it’s to feed the muscles. But these days, most of our stress is not caused by a physical need.”
24:53 – Blood glucose is highly individual
Experts used to think that sticking to food with a low glycemic index would work for everyone. But it turns out that it’s far more complicated than that, and everyone processes carbohydrates differently.
“We’re realizing more and more that there’s actually biochemical individuality between, you know, even you and I. We can both eat the exact same identical banana and my blood sugar could go through the roof and your blood sugar could stay fairly stable. And the reason for that likely has to do with factors like microbiome composition, baseline insulin sensitivity, how much sleep you had the night before. These are the factors that can kind of predict the difference. So really testing how foods affect our glucose levels is a really good start for figuring out diets and a comprehensive diet that keeps glucose stable. Aside from sort of figuring out what’s a spiker for you and what’s not, there’s other things you can do as well. You can pair foods in a thoughtful way. So eating carbs alone, it’s almost certainly going to spike glucose more than if you pair it with a fat or a protein. Food timing matters. There’s quite a bit of research to suggest that eating very late at night has more of an impact on your glucose than if you eat sort of earlier in the morning.”
31:13 – Metabolic health and COVID-19
People with disorders related to metabolic health like diabetes and obesity are having worse outcomes with COVID-19. There is also evidence that COVID-19 can have negative effects on insulin production.
“So what has been found is that immune cells are actually somehow sort of almost deactivated by very, very high blood sugar. And there’s specific things that immune system cells have to do to basically fight a virus or bacteria. One of those is called phagocytosis and that’s the process of an immune cell literally eating a bacterial cell or a virally infected cell. It’s called phagocytosis. That process seems to be stunted when there’s high blood glucose. And you can actually look at cells in a Petri dish with high glucose and see them kind of not moving properly and not doing this process properly. The immune cells have to actually move to the parts of the body where the virus or the bacteria are, and that’s a process called chemotaxis. That movement of cells is actually also inhibited by high glucose. So again, you look in the Petri dish, you see the cells and they’re just not functioning properly. So it’s really interesting. And when you think about back to the sort of metabolic health and generating energy for cells to work, you know, for cells to move or for cells to quote unquote, ‘eat other cells,’ these things take energy. So if there is an energetic problem in the cell, they’re not gonna be able to work properly.”
39:31 – Chronic inflammation can lead to other health issues
High blood glucose can lead to an overreaction of the immune system as well, which can result in chronic inflammation. That inflammation could be the cause of other health issues like thyroid disorders and chronic ear infections.
“I think the more that we can keep our bodies in sort of a state of less threat, less alarm, less like, we asked to be activated, the less inflammatory symptoms we’re going to see. We know that high sugar foods and things that spike glucose levels, these things tell our body that there is a threat. They are directly signaling our body that there’s a problem. So certainly I think for anyone with an inflammatory-based condition or disorder, one of the easiest things that we can do is just remove the refined sugar, the processed sugar, or the refined grains, the hyper-inflammatory foods, and try it for a few months. What’s the worst that can happen, you know? A lot of people see some of these inflammatory symptoms really subside. It’s definitely a low-hanging fruit.”
41:33 – Tracking and accountability is essential
In order to improve the four pillars of health — food, sleep, exercise, and stress management — you need tools that keep you accountable.
“This is where I’ve just been very excited by a lot of the tools that are coming around to help keep us on track for our sleep, our exercise, our stress. Things like Fitbits or Whoops, Lief Therapeutics has a heart rate variability monitor, sleep trackers. Then for nutrition and glucose, the company that I started Levels is helping people track glucose levels. But now there’s ways to actually stay accountable and stay informed to make personal decisions about all of these things. So it’s a very exciting time. When you look at the research, like for instance, with a Fitbit or a step counter, people are more active, statistically significantly more active, when they wear a fitness tracker. So they actually do seem to move the needle. I think that it’s exciting that we full circle have ways to track and stay accountable on all these different four pillars.”
43:24 – Levels is bringing that same accountability to nutrition
The other trackers on the market help us make good decisions with fitness, sleep, and even stress. Levels helps with food.
“We don’t have any way to have a closed loop system between what we eat and what immediately is happening to our health, but there is this fantastic technology that exists, which is called a continuous glucose monitor that is like a wearable, just like a Fitbit or an Oura Ring. You wear it on your arm and it’s tracking your glucose 24 hours a day. You can see after every bite you take or every stressful call you take, or each night of good or bad sleep, exactly how it’s affecting your glucose in real time. You have your oatmeal and an hour later, you know exactly how that affected you. So this is technology that’s actually existed for more than 10 years, but it’s been really sequestered to a very small population of people who are treating type one or type two diabetes. This is a tool that has been used for tracking the disease and helping with medication management. What my company has done is bring this technology to the wider market, to anyone who’s looking to personalize their nutrition, to get biofeedback based on glucose levels and to pair it with software that takes that glucose data stream and actually helps you figure out what to do, what choices are going to help you move in the direction of that flatter and more stable glucose line and how you can really pair all these behaviors together to create the most optimal metabolic context in your body.”
46:07 – Metabolic health is not fixed
The good news is that you can improve your metabolic health by taking steps in the right direction and sticking to better habits.
“The beauty about metabolic health is that it is not deterministic. We are on a spectrum from perfect metabolic health to really struggling with our metabolic health. But in no way is that a one way street. We can always move in the other direction, and to do that, we have to improve our insulin sensitivity. We have to get our body back to processing energy effectively. And the first step with this is managing our glucose levels. Every single day, we have to start thinking about this, about our metabolic health. Like we think about working out. We go to the gym every day and we lift weights and we do the cardio and we see things get better and we see things get easier over time and that is this sort of slow, gradual improvement. We do the reps and we get results and that’s exactly what has to happen with metabolic health. The reps for metabolic health though, are keeping glucose more stable and lower day after day. And as you do that, your body perks up again, it becomes sensitive again to the insulin.”
57:11 – Digital tools could get us back to a natural balance
The future of wellness could be using digital tools bringing us back to basic health and natural rhythms.
“I think the next frontier is going to be seeing really doing this with our digital tools, and how can these things that we have with us every day be agents of positive behavior change in our lives? Because fundamentally, we’re not going to reverse our chronic disease epidemics If we don’t change the way we’re living. I’m interested in how tools can scale for that in a really delightful, enjoyable, engaging way. And hopefully these tools, even though they are digital and they’re tech enabled, I’m hoping that they will actually help people tap into really understanding their bodies and getting into a whole renewed sense of somatic awareness. So I think it’s going to be like a boomerang. We use advanced tech-like tools, but we actually come back to the basics. We come back to eating healthily, eating whole foods, you know, eating close to the earth, exercising, getting more sleep, engaging with loved ones to reduce our stress, doing mind-body practices to reduce stress. So how can we use technology to get us back to the basics and really understand our bodies and feel what’s happening inside of us?”